隨堂筆記

POP
pelvic relaxation--> increased bladder neck mobility
relaxation: perineum descend, genital hiatus opening
pudenal nerve--> denervation --> 80% reinnervation
body weight increased--pelvis pressure
elective C/S-->1. fear of labor pain, 2.pelvic floor weakness, 3.sex disorder
placenta-->D&C, C/S-->placenta accrete, placenta previa
Ask not what childbirth can do to your pelvic floor, ask what your pelvic floor can do in childbirth
Kegel (kigl) exercise in 3 months-->serial trauma and recovery-->vit C(collagen fiber), nutrition, exercise, 　　control BW
elective C/S比NSD不傷pelvic floor, 但是50歲以後則沒有差異

老年
Add years to life, add life to years
Successful aging
資生丸(養生), 老年感冒(玉屏風散), 骨質疏鬆(左右歸丸), 更年期(牛黃清心丸,二仙湯, 二至丸),
老年便秘(補中益氣加肉從蓉, 麻仁丸)

懷孕用藥
懷孕一個月內: all or none, no effect or complete cell destruction and death
4-12 wks embryogenesis: differentiation & organogenesis, dysmorphogenic effect(cleft palate, CHD)
> 12 wks fetogenic period: cell death & growth retardation, function disturbance(IUGR)
cytochrome P450 mediated enzyme
. danazole(女嬰男性化), Lithium(Ebstain anomaly), Indomethacin(PDA closure)
查詢--www.perinatology.com, www.safebaby.com
cough可用codeine, hypertension用labetalol, methyldopa, hyperthyroidism用PTU
ampicillin, amoxillin-->rapid cross placenta
Augmentin(ampicillin+clavulanate)-->spina bifida, NEC
Cephalexin-->CV defect, oral clefts
3rd trimester用sulfonamide-->severe jaundice(compete albumin with bilirubin)
Baktar(trimethoprim+sulfonamide)-->CV defect
Aminoglycoside(endometritis, septic abortion, G(-)infection)不與cephalosporin同用-->nephrotoxicity
Gentamicin-->no ototoxicity
Metronidazole-->1st trimester 不用
Tetracycline-->抑fibular growth in 2nd trimester(reversible)
Erythromycin-->poorly across placenta, hepatotoxicity in pregnant woman, infantile hypertrophic pyloric 　　stenosis
Clindamycin-->bacteria vaginosis
Fluconazole 150mg single dose--> 1st trimester
Used only in clearly indicated

老年肺炎5%死亡
bacteria會胸痛, virus不會
用erythromycin-->Legionella
pneumococcus變異性少-->5年打一次, influenzaA變異大-->一年一次

過動兒
過動兒的藥物治療: Ritalin, Anti-depressant, Haldol

青春痘
Diane 含Cyproterone acetate 2mg及ethinyl estradiol 35mcg用青春痘來治, 每天一粒, 吃三星期, 吃三個週期. 男性吃Androcur每天四分之一顆(一顆50 mg)